DESCRIPTION: (Applicant's Description) The overall aim of this training program is to improve end of life (EOL) care for patients receiving services from non-hospice, home care agencies (HCA). The specific aims are to 1) Implement the Home care Outreach for Palliative care Education (HOPE) curriculum focusing on priority topics in end of life care including pain management, symptom management, communication with terminally ill patients and families, and improving the care surrounding the death event at home; 2) Develop and implement a parallel home health aide HOPE curriculum; 3) Provide a Trainers workshop to prepare 50 agencies to implement the HOPE curriculum in their own settings; 4) Evaluate the impact of the HOPE curriculum on home care staff knowledge and beliefs, agency feedback from the project and system changes, and impact on care of actual home care patients; and 5) Refine the HOPE curriculum for broad dissemination to home care agencies for improved end of life care. This project follows the completion of a one-year pilot project funded by the Project on Death in America to the City of Hope investigators from August, 1996 - August, 1997. The HOPE pilot project began with a needs assessment of 134 home care agencies to design a curriculum to meet their needs and which is also realistic for implementation in the current health care environment. The pilot HOPE project developed the complete curriculum and teaching materials for improved end of life care in non-hospice home care agencies. The pilot also included implementation and evaluation of the complete curriculum in two agencies. Evaluation data demonstrated the strengths of the project and perceived effectiveness by the two agencies in improving end of life care for their patients. This proposed project occurs in two phases. Phase I extends the HOPE curriculum to an additional 10 agencies in the Los Angeles area and Phase II translates this curriculum to 50 additional agencies drawn from a national pool of applicants. The project includes a strong evaluation plan to measure the effects of the HOPE curriculum on end of life are. This training project is designed to improve end of life care in home care by training an estimated 1800 home care professionals and home health aides and to establish a model education program for further dissemination.